During the last half of the 20th century, medicine and healthcare became increasingly focused on treatment and with good reason; medical procedures and medications were able to turn the tide on many of the major killers that once plagued us. Antibiotics all but eliminated many infectious diseases and life-saving procedures, such as coronary artery bypass graft surgery to name one, extended life as never before.
This approach to health has grown into a cultural mindset of healthcare consumerism; preventing disease, and preserving health, is about screening, medications and medical procedures. A pill for every woe.
And while we’re more than happy to buy what the health care system is selling, are we getting our money’s worth? Are we really making a dent in chronic disease?
Prevention versus treatment
It’s been my experience that most people aren’t sold on the idea that diet and supplements can truly have an impact on prevention [or at least greatly reduce the onset/severity of] chronic diseases. The prevailing thought in medicine is that if a person is eating reasonably well and doesn’t have an overt/obvious/clinical deficiency [i.e. scurvy, pellagra, goiter], then diet has done all it can do. The only reasonable next steps in most people’s mind would be a drug or medical procedure.
Why is that?
Turns out that the people hugely overestimate the benefits of screening and/or medications to prevent and manage chronic disease. A study in the Annals of Family Medicine found that the majority of people, 69-94% of those surveyed, thought the benefits were much greater than they actually are. Not only that, but the minimum perceived benefit from using a medication or screening that a person perceives as ‘worth the effort’ is much higher than the actual benefit studies have found. If told the truth about the actual risk reduction, most (90%) said they wouldn’t even bother.
Patients’ Expectations of Screening and Preventive Treatments
In one study, participants estimated lipid [cholesterol/triglycerides] lowering medications to be 100x more effective than they actually are in preventing heart attacks; if told the absolute/real reduction in risk was only 3-5%, nearly everyone surveyed said they wouldn’t take them. Similar results are seen with antidepressants which were found to be no more effective than placebo at improving mild to moderate depression when looking at the bulk of the evidence. Sleeping pills? Not even close.
Patient Expectations on Lipid-Lowering Drugs
Active Placebos versus Antidepressants fro Depression
If people underestimate the benefits of lifestyle [diet, exercise, leisure, sleep, stress reduction etc] and overestimate the benefits of screening and medications, it’s no wonder we’re a society of believers thinking ‘medicine’ is all we need to fix our chronic health issues despite the lack of evidence.
Where medicine does do well
Medicine really shines in treating acute illnesses such as infections or trauma [emergency room] etc where people receive short-term treatments for severe injuries, or episode of illness or urgent medical conditions but for treating chronic disease, not so much. Why this is such a shame is because chronic diseases are the leading cause of death and disability and sadly, modern medicine falls short.
However, people are in the dark about this too. It turns out that our perceptions about the treatment of chronic disease is just as exaggerated as prevention. While a very large study of more than 200,000 trials found modest benefits from some medications and procedures, for the vast, vast majority of treatments, real benefits are rare, as is any evidence to support the use of these treatments.
Empirical Evaluation of Very Large Treatment Effects of Medical Interventions
When it comes to reducing mortality (death) associated with chronic disease and increasing lifespan, the evidence is nonexistent for most medical interventions of chronic disease and this makes sense. We are physical beings first and foremost; flesh and bone as the saying goes; made of organic matter running on metabolic pathways with a never-ending need for fuel and the building blocks that make up our biology. True healing can’t happen if the body is starving for essential nutrients: fat, protein, vitamins and minerals because:
“you can’t out medicate an unhealthy lifestyle”
All the lipid (blood fat) and blood sugar -lowering medications, or anti-depressants in the world cannot make up for a lack of magnesium, vitamin D or omega-3 fats for example nor will those medications provide our cells and tissues the very nutrients they need for optimal metabolism. How could they?
What does work?
Lifestyle approaches to managing chronic disease often work best. Studies have found impressive returns on investments when it comes to improving diet quality, appropriate use of supplements, improving sleep quality, exercise and stress reduction. Not only that, lifestyle often makes medications and other procedures more effective.
Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts
Omega-3 fatty acids in psychiatry: a review
Rapid recovery from major depression using magnesium treatment
Folate and depression – a neglected problem
L-methyl folate – a promising therapy for treatment-resistant depression?
Calcium & vitamin D for treating osteoporosis caused by the use of steroids
While we’ve come along way from the days of leeches, blood letting and having only one notable medication to treat almost everything [Aspirin], modern medicine hasn’t progress far when it comes to the successful prevention of chronic degenerative diseases nor their treatment. It’s time to put this all into perspective. There is a time and place for prudent screening and medication use but it’s a tad naive to think this all it’s gonna take to reduce illness and disability on their own. Health can only truly thrive in the context of a healthy and strong body; one that requires optimal nutrition [yes, often requiring supplements], stress reduction, good quality sleep and leisure without which, as the evidence points out, we’re really no better off than doing nothing at all.